The Future of Exercise and Parkinson’s: Emerging Therapies and Research Frontiers

What if the future of Parkinson’s care was already taking shape — and it looked nothing like the rehab you know today? In this inspiring, research‑packed episode, we explore how AI, robotics, wearable tech, virtual and augmented reality, and breakthrough neuroscience are transforming exercise into a powerful, personalized therapy for Parkinson’s.

From boosting brain‑derived neurotrophic factor (BDNF) to harnessing the gut‑brain axis, you’ll discover how cutting‑edge science is unlocking new ways to protect the brain, improve movement, and enhance quality of life. Whether you’re newly diagnosed, a long‑time Parkinson’s warrior, or a care partner, this episode will leave you informed, empowered, and excited about what’s ahead.

In this episode, you’ll learn:

• 🚀 How AI‑driven exercise prescriptions are being developed to adapt in real time to your symptoms and energy levels.
• 🤖 The latest on robotic exoskeletons and assistive devices that retrain gait and balance.
• 🥽 How VR and AR rehab can reduce freezing of gait, improve coordination, and make exercise fun.
• ⌚ Why next‑gen wearables could predict “off” periods before they happen.
• 🧠 The role of BDNF, motor learning, and biomarkers in slowing Parkinson’s progression.
• 🦠 How exercise may influence the gut microbiome to reduce inflammation and protect neurons.
• 📅 What to expect in the next 2–3 years, 5–10 years, and beyond in Parkinson’s exercise therapy.

This isn’t just about gadgets — it’s about living better, longer, and stronger with Parkinson’s.

💡 Stay connected & get free resources: Visit liveparkinsons.com to subscribe to the free monthly newsletter and access valuable tools like the Parkinson’s Symptom and Medication Tracker.

☕ Support the mission: If you believe in helping people with Parkinson’s lead an exceptional quality of life, you can support the podcast and my work at ko-fi.com/liveparkinsons.

📖 Read my story & strategies: Discover my personal journey and proven approaches in my book Spectacular Life – 4 Essential Strategies for Living with Parkinson’s, available now on Amazon.

Chapters

• 0:00 Exercise as Medicine for Parkinson's
• 3:02 AI and Wearable Technologies
• 4:56 VR and Augmented Reality Rehab
• 7:15 BDNF and Neuroplasticity Research
• 9:02 Future Roadmap of Exercise Technology
• 15:02 Closing Thoughts and Resources

Transcript

Speaker 1: 0:10

Hello and welcome to Live Parkinson's Live an Exceptional Life. I'm your host, chris Kustenbader, and I've been living an exceptional life with Parkinson's for the past 15 years. The mission of this podcast is to help as many people as possible living with Parkinson's to lead a great quality of life. Now, today, we're diving into the future of exercise and Parkinson's, where cutting edge science meets hope and where technology is rewriting the rules of rehabilitation. All right, I want you to close your eyes for a second, that is, unless you're driving, in which case please don't. But it's the year 2035. You wake up, you slip into a featherlight robotic suit that syncs with your nervous system. It senses your stiffness before you do, it gently mobilizes your joints and guides you through a workout tailored to your brain's needs. On that specific day, your living room morphs into a sunlit Tuscan vineyard via augmented reality, and your wearable sensors stream real-time brain and movement data to your neurologist. Now here's the kicker Every step you take is not just keeping you fit. It's actively protecting your neurons, boosting brain chemicals like BDNF, which we'll talk a little bit about later, and maybe even slowing Parkinson's progression. Now it sounds like science fiction, doesn't it? Well, the truth is, much of this is already in clinical trials. You've probably heard me say it before, but exercise is medicine. But now the science is catching up in a big way. A 2023 review in the Journal of Neurology, neurosurgery and Psychiatry by Langoskav Christensen and colleagues concluded that exercise can act as a primary prevention by lowering the risk of developing Parkinson's, as a secondary prevention by slowing the disease progression, and as a tertiary prevention by helping to improve symptoms. And then there was a 2024 meta-analysis in brain sciences by Kegman et al that pulled data from five randomized controlled trials, and what they found was that structured exercise significantly increased serum BDNF. Now, bdnf is the brain-derived neurotropic factor, and think of it this way it's your brain's own growth fertilizer and it improves your motor scores, your walking distance and your balance. Now you can tell I get bored pretty easily and sit around looking up clinical studies, but try to bear with me, all right. So we're not talking about feeling better after a workout. We're talking about exercise as potential neuroprotective therapy. Now, unlike pills, the side effects are mostly limited to sore muscles. And then maybe the occasional awkward moment when your smartwatch congratulates you for a workout. That was actually just you chasing your dog through the yard. All right. So let's talk about the tech that's making all this possible, and let's start out with AI and wearable sensors. Now, researchers are now combining wearable sensors with artificial intelligence to track and improve your movement. So, for example, the Mody Gravity Platform tested in the 2025 Journal of Clinical Medicine study, uses inertial sensors in a hypogravity treadmill to collect precise data movement. So it's an AI model that classified Parkinsonian versus healthy movement patterns with 100% validation accuracy in a pilot study. That's pretty impressive. Now, at the University of Illinois, hernandez and colleagues in 2024 showed that low-cost wearable sensors plus deep learning improved detection of motor impairments by 12% over standard models. And at the University of Maryland, khalil in 2024, used a single lower back sensor with machine learning to distinguish Parkinson's from control groups with 92.6% accuracy.

Speaker 1: 4:13

All right, now let's talk a little bit about robotic exoskeletons. These are pretty exciting. Now. These are devices like the XONR and Japan's HAL hybrid assistive limb, and they're being trialed for gait training. Now, they don't just move your legs, they respond to your own neural signals, helping you retrain your body and your brain connection. Now, early studies showed that improved stride length, reduced freezing and better balance were the results of using these new exoskeleton technologies. Now what's the benefit? Well, these systems can deliver thousands of perfect, repeatable steps in a session, something that's hard to achieve by just using human therapists alone.

Speaker 1: 5:02

All right, now let's take a step into the matrix in a good way, and let's talk about virtual reality. Now virtual reality is being used to create immersive rehab environments. There was a 2023 study in the Journal of Neuroengineering and Rehabilitation that found that virtual reality balance training, improved gait and reduced fall risk in Parkinson's patients. So imagine walking along a beach, stepping over some driftwood, while your brain is actually learning to adapt to real-world obstacles. So that's actually pretty cool. So they can actually set up obstacles using the virtual reality, and then you can practice in a safe environment. And then augmented reality it overlays visual cues in your real environment. So there's devices like the QSTIM that's C-U-E-S-T-I-M, so the QSTIM glasses. What they do is they project stepping stones on the floor to help you overcome freezing of gait. So early trials have shown significant improvements in both walking speed and reduce freezing episodes. So the benefit of these particular tools virtual reality and augmented reality are that they make rehab engaging, gamified. So if you're having a good time, you're more likely to participate and keep coming back to do it again, and they're adaptable. And another benefit is that they can be done at home.

Speaker 1: 6:31

All right, let's talk a little bit now about wearable technologies. So, from smart watches to advanced biosensors, wearables are becoming mini health labs. There's a watch out there called the PKG watch from Global Kinetics. That's FDA cleared for continuous movement monitoring. Movement monitoring and what this watch does is it tracks your tremor, bradykinesia and dyskinesia over days, helping doctors fine-tune medication timing. I think that's pretty fascinating. Now some wearables now integrate with AI to predict your off periods before they happen, giving you a heads up to plan your daily activities. So that way you'll kind of have a heads up and know when you might be experiencing your off times.

Speaker 1: 7:15

All right, now let's move on and talk about BDNF and some of the breakthrough research that's going on with BDNF, motor learning and some biomarkers. So let's geek out, if you will, with me for just a minute. So BDNF again stands for brain-derived neurotropic factor and what it does? It supports neuron growth and survival, and I need plenty of that, that's for sure. In a study in Frontiers in Physiology by Paterno in 2024, they found that higher intensity exercise correlated with greater BDNF increases in people with Parkinson's. And then in another study in translational neurodegeneration, link these boosts to improve motor scores as well. So that's pretty impressive.

Speaker 1: 8:04

Now, in terms of motor learning research, motor learning research has shown that the brain can rewire itself through targeted, repetitive practice, and we typically use that term neuroplasticity so especially when combined with real-time feedback from sensors or virtual reality. So you can use virtual reality and sensors, as well as motor learning, to help rewire your brain, which I think is pretty spectacular. And then in terms of biomarkers, now these are think is pretty spectacular. And then, in terms of biomarkers, now these are the holy grail. These are blood tests or imaging that can track how exercise impacts disease progression. And what scientists are doing is they're exploring alpha-synuclein, which is a protein that clumps in people with Parkinson's. So they're exploring alpha-synuclein assays and advanced MRI to measure neuroplasticity changes.

Speaker 1: 8:56

All right, now here's where things get really interesting. We'll talk a little bit about combination therapies and the gut-brain axis. All right, we'll start off with combination therapies. Now trials are pairing exercise with non-invasive brain stimulation like TDSC or TMS to enhance motor learning. Now the idea is to prime your brain so that it's more receptive to the benefits of exercise. Now I need plenty of that. My brain needs priming all the time, I think. So these trials that they're doing are pretty fascinating in that you're teaming exercise with non-invasive brain stimulation.

Speaker 1: 9:36

And then in terms of gut-brain access, which I've talked about before, remember we have trillions of bacteria, fungi, living in our gut and we have what's called good and bad bacteria, and they're involved in our immune system as well as communicating with our brain. And in terms of the gut-brain axis, there was a study published by Zapanta in 2022 in physical therapy, and they suggested that exercise may restore gut microbiota diversity, potentially reducing neuroinflammation, and neuroinflammation is one of the risk factors that they believe are involved in Parkinson's. Now the Parkinson's Foundation notes that people with PD often have altered gut bacteria profiles and that by changing that, we could help to influence the symptoms. So I think that's pretty fascinating that exercise might help impact your gut flora and help you with your Parkinson's symptoms. All right, now let's talk a little bit about the road ahead, what's coming down the pike in terms of exercise, and let's do some time travel and look at what's in the pipeline in the next two to three years, and then we'll talk about what's five to 10 years out and then 10 plus years out All right.

Speaker 1: 10:57

So let's look at the next two to three years, from 2025 to 2027. And we'll start off with AI driven personalized exercise prescriptions. Say what AI platforms are going to be able to analyze your movement data, symptom patterns and even biomarker results to create daily exercise plans that are tailored to meet your needs. So imagine an app that notices your gait slightly off today and it swaps your planned cycling session for targeted balance drills. I think that's really cool. So you might go to the gym thinking you're going to do one thing, but the app is able to read your movements and your symptoms and suggest something else. Next up is wider adoption of both virtual reality and augmented reality rehab at home Things like virtual reality boxing programs that can adapt to tremor patterns, and then augmented reality glasses that are able to project stepping cues to help you overcome freezing. So this makes therapy engaging, accessible and fun. And then, third, in the next two to three years, you're going to see wearables that are going to be able to predict off periods. So you're going to have smart devices that will forecast when symptoms will worsen, and they're going to be able to give you a heads up to adjust your medication or help you plan your activities, so think of it as a weather forecast for your motor symptoms. I think that's really awesome Now, five to 10 years out, from 2030 to 2035,.

Speaker 1: 12:27

One of the things they're going to have is affordable home use robotic gait trainers. They're compact, cost-effective devices that bring clinical level gait therapy right into your home. So you strap in, you walk and you let the robot guide your perfect stride. And then next up is biomarker guided exercise programs, and what these are is exercise prescriptions based on measurable biological indicators like BDNF levels or alpha-synuclein concentrations. Your workout could be fine-tuned, really based just on a simple blood test. And then, finally, gut microbiome profiling integrated into rehab. So stool sample analysis to understand your gut bacteria, and then they're going to pair that with an exercise plan, with dietary tweaks or probiotics for optimal gut health. All the things that they're working on. It's really fascinating.

Speaker 1: 13:26

And then in 10 plus years, where we're talking 2035 and beyond, they're going to have a fully immersible AI adaptive exercise ecosystem. These are smart rehab rooms that adapt lighting, sound, visuals and exercise equipment in real time based on your brain and your body signals. That's actually pretty fascinating. And then you're going to have real-time brain imaging feedback during your exercise workouts. So there's going to be portable brain monitoring that's going to allow you to show how your motor cortex responds to each type of exercise, letting you and your therapist fine-tune in the moment while you're exercising.

Speaker 1: 14:12

And then, third, is large-scale proof of disease-modifying effects.

Speaker 1: 14:13

There's decade-long global trials that are going to confirm that exercise is one of the keys to helping you slow the progression of the disease. So that's a quick overview of some of the things that are coming down the exercise pike and helping you live your best life with Parkinson's. So really, the future of exercise and Parkinson's is going to be about moving smarter, not just moving more. It's going to be about blending human determination with some of these tools like AI, robotics and biology to not just manage symptoms, but to really to help to change the trajectory of the disease. Now all this technology is exciting trajectory of the disease. Now, all this technology is exciting. The science is promising, but the real magic that's you Showing up, moving and believing in a better tomorrow is going to help in the long run.

Speaker 1: 15:04

So it's important that you stay consistent with your exercise program and that you show up and give it your best shot Now. For more information, please visit my website, liveparkinsonscom, and subscribe to the free monthly newsletter where I keep you updated on all the latest research, clinical trials, webinars and seminars that are going on, and there's also valuable free resources like the Parkinson's Medication and Symptom Tracker, as well as nine balance exercises to help you improve your balance with Parkinson's. And then, in addition, if you want to support my mission to help as many people as possible living with Parkinson's and to help keep the program going, please consider visiting my Ko-fi page at ko-ficom slash liveparkinsons and donating to help support the mission. I want to thank you again for listening and remember stay strong, stay healthy and live your best life with Parkinson's. I have faith in you and I hope you have faith in yourself. See you again next time and have a great week.